1. Field of the Invention
The present invention relates to a method and apparatus to objectively measure stress and fatigue, record stress and fatigue related data in a standardized database, create automated prompts and alerts based upon pre-defined stress and fatigue thresholds (which are derived based upon individual end-user and task performance), provide a number of interventions (which can be preferentially selected by the individual end-user), create data-driven best practice guidelines though meta-analysis of the database, and provide an objective tool for comparative technology assessment.
2. Description of the Related Art
Stress and fatigue are commonly encountered challenges within contemporary medical practice and affect all healthcare professionals to varying degrees. Over the past few years, a number of factors have served to increase stress and fatigue among healthcare professionals including (but not limited to) reduced reimbursements (with a resulting emphasis on increased productivity and workflow), increased scrutiny on quality and safety, changing regulations, and the digitization of medical practice.
In current medical practice, healthcare professionals are to a large degree left to their own devices. If and when a physician is tired, stressed, or fatigued, they must not only identify the concern but also unilaterally take action to avoid error. This is often impractical given workload demands, time constraints, and lack of availability of a readily available replacement. As a result, the physician often continues work, with the potential to alter workflow, operational efficiency, quality of performance, or patient safety. In addition, a culture of perseverance often exists, which encourages healthcare professionals to “work through” the stress/fatigue. The only way to correctly ascertain how this impacts clinical outcomes is through prospective data collection and analysis, which is currently unavailable given the lack of supporting technology. Current workflow analysis is largely performed on a “macro” and retrospective level, where individual healthcare workers and departments are evaluated on the basis of cumulative productivity (e.g., annual exams or procedures) or operational efficiencies (e.g., patient waiting times or backlogs). Since increased emphasis is placed on productivity and operational efficiency, minimal effort is made to identify causative factors of stress and fatigue and potential remedies.
A number of landmark publications have been issued from the Institute of Medicine which has highlighted the unexpectedly high frequency of medical errors and occupational stress/fatigue among healthcare professionals. These publications have cited the relatively high frequency of medical errors resulting in avoidable deaths, magnifying the importance of operator vigilance, concentration, and computerized decision support. Thus, technology has been a double-edged sword for healthcare providers. On one hand it has dramatically improved the quality and accessibility of data, while on the other hand it has created heightened expectations on the part of consumers and increased stress on the part of service providers, which is highly variable in accordance with the individual end-user's technology proclivity, education/training, and occupational demands.
In addition, the analysis of data in medical practice is complex and comes in multiple forms; including textual, numerical, graphical, and imaging data. Healthcare professionals must be able to review this multi-disciplinary data and make rapid and well-informed decisions. Any form of visual fatigue can potentially impair data recognition and analysis, while cognitive fatigue can lead to faulty and/or delayed decision-making.
The digitization of medical practice has profoundly changed the manner in which medical data is recorded, transmitted, accessed, and analyzed. While this digitization has improved data accessibility, it has also presented healthcare professionals with less “down time” in which they can take a break, decompress, and relax from high pressure occupational demands. The ubiquitous nature of data within the electronic medical record and other healthcare information system technologies creates continuous demand for continuous workflow, which in turn can serve as a stress and fatigue multiplier. The end result is that data intensive occupations which rely on instantaneous decision-making with the potential for catastrophic results are particularly vulnerable to stress and fatigue induced error.
An additional factor contributing to occupational stress and fatigue is sleep deprivation, which can be of particular concern in occupations and workers during evening and night time shifts, in which natural circadian rhythms are disrupted. A large number of reports have cited concerns over stress and fatigue within medical practice and the exacerbation caused by sleep deprivation. The criticality of the problem is best illustrated in critically ill and emergent patient populations, where a small time delay or oversight can lead to the difference between life and death.
An additional deficiency of current technology is the “one size fits all” approach, which essentially treats all end-users as a homogeneous population. Differences in occupation, education, personality, computer proclivity, and sensory/motor skills are largely ignored. Instead, end-users are forced to adapt to the technology, rather than the technology being adaptive to their unique needs.
Occupational stress and fatigue is not solely the domain of healthcare professionals and is also commonly found within other occupations exposed to high pressure productivity/workflow demands, increased quality and safety concerns, and prolonged periods of time interacting with a computer. These include (but are not limited to) the transportation, defense, engineering, and software industries. A great deal of work has been dedicated to airline pilots and traffic controllers, who are prone to occupational stress and fatigue, with the potential for instantaneous catastrophe, in the event of an oversight or error.
Thus, a proactive technology which can account for inter-user variability and introduce accommodative measures has the potential to improve performance, while also reducing or minimizing occupational stress and fatigue, would be advantageous. Further, a technology which can potentially diagnose stress and fatigue, and intervene in the end-user's performance in real-time, could provide tremendous benefit on a number of levels including improved workflow, safety, quality, and morale.